Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Intensive care · Burn injury · Energy expenditure ·

Critical illness · Nutritional support

Key Messages

• Malnutrition leads to increased morbidity and mor-
  tality in pediatric hospital patients, with particularly
  severe consequences in critically ill children


• Both under- and overfeeding have negative conse-
  quences


• Nutritional support for the critically ill child is an es-
  sential aspect of clinical management and should
  be integrated into daily care


• Nutritional guidelines in this area are not evidence
  based, because little research has been conducted
  © 2015 S. Karger AG, Basel

Introduction

During critical illness and recovery thereafter, ad-
equate nutritional support is an essential aspect of
the clinical management of pediatric intensive
care patients. Adequate feeding is essential for
complete recovery and normal functioning of the
growing child. Thus clinicians in the pediatric in-
tensive care unit (PICU) are challenged to pro-

vide adequate nutrition for optimal tissue synthe-

sis and immune function while avoiding compli-

cations of under- or overfeeding.

The prevalence of malnutrition among chil-

dren admitted to a PICU, including burn and

trauma patients, is high [1–3]. Protein-energy

malnutrition in hospital patients is associated

with increased mortality and morbidity, includ-

ing a higher risk of infections due to poor im-

mune defense, wound healing problems, reduced

gut function, longer dependency on mechanical

ventilation and longer hospital stay [1, 4].

Studies have shown that the nutritional status

of children admitted to a PICU deteriorates dur-

ing hospitalization [2] as children often do not

receive adequate feeding. Besides underfeeding,

overfeeding also has negative consequences: it is

of no benefit in maintaining lean body mass and

results in the excessive synthesis of fat. This may

induce hepatic steatosis and impaired liver func-

tion and increase the risk of hyperglycemia. Hy-

perglycemia itself results in a higher mortality

and morbidity in critically ill children [5]. Nutri-

tion delivery is generally inadequate in critically

ill children. Improved adequacy of energy intake

has been shown to improve mortality and mor-

bidity [6].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 271–277
DOI: 10.1159/000360351

3.24 Intensive Care

Jessie M. Hulst  Koen F.M. Joosten

3